Earlier this year, Ascension, the nation's third-largest Catholic health system in terms of operating revenue, announced a major shake-up in its C-suite. After 15 years, Anthony Tersigni would retire from his position as president and CEO while continuing to serve on the executive committee of the system's investment fund. Three other top executives also would leave the organization. Ascension carefully trains future leaders and as such, its next CEO was already being groomed for the position. Joseph Impicciche took over the corner office a little over two months ago after being promoted to president and chief operating officer in January. He previously served as executive vice president and general counsel for the health system starting in 2004. While his title is transitional, Impicciche is very much thinking about how his leadership will impact the 151-hospital system. He recently sat down with Modern Healthcare Editor Aurora Aguilar for his first one-on-one interview as CEO. The following is an edited transcript.
MH: When you first were promoted in January, the office of president and CEO had been split, but it has since been rejoined. Why?
Impicciche: I see my role as transitioning a well-established leadership team to a new generation of leaders. When Tony asked me to serve as president and chief operating officer, I was delighted to do so, but because we had begun to flatten the organization, it didn't really make a lot of sense to have the two roles, and so that's why they came together.
MH: Have you set goals either short-term or long-term for yourself or the organization?
Impicciche: Tony laid a terrific foundation for our advanced strategic direction. As that progressed, we began our mission inspired transformation work. This work is really propelling our strategic direction forward. We've made the organization more nimble and we've empowered our leaders with more decisionmaking authority. We've also created eight design teams that work in an agile fashion to help transform the organization.
One team is focused on healing and health in the home. Another one is looking at redesigning our front doors. How do we increase our access points? One focuses on human flourishing. How do we tackle the social determinants of health? Another focuses on caregivers. How do we help redesign that model so that nurses are practicing at the top of their license, bringing joy back to their practice? We're looking at redesigning our surgical service line, as well as reimagining our acute-care footprint. And we also have one team focusing on growing covered lives through strategic purchasing contracts and another focused on the consumer experience—an end-to-end journey with the consumer. This has led to changes in our digital platform and that work is well underway. It's a big part of our transformation process.
MH: It's interesting that you have consumers separated from access, since online scheduling has provided significant dividends for your organization.
Impicciche: This work is very integrated. The eight design teams are working together in a very integrated fashion. Each team has an executive sponsor from among our senior leaders, and the teams that have been assembled include associates from across our ministries. It's a group of about 150 highly engaged associates from across the country.
There's a lot of excitement and energy around this work. We recently had the phase-three kickoff in St. Louis, and many of these teams are beginning to launch pilots across the ministry. For example, our Nursing Center of Excellence, the redesign work in nursing, is being piloted at our hospital in Jacksonville, Fla. St. Vincent Riverside Hospital was the first pilot for that work.
MH: Is there a set-aside budget for these endeavors?
Impicciche: When we first commissioned these design teams, we asked them to "take off the shackles" and think outside the box, and not worry about the capital investment. We asked them to just think about the work and how we can help transform the organization. That's exactly what they did. As that work has developed and coalesced, we've begun to take a look at what it's going to cost to implement the work, and we've included it as part of our budget moving forward.
MH: Ascension in the past few years has moved away from hospital care. Are these pilots taking you in that direction?
Impicciche: Yes, I would say that they are. A lot of the work we're doing focuses on how we meet the consumer where he or she may live and what their needs would be. For example, we've recently launched the Ascension on Demand virtual care platform. So patients have the ability to reach Ascension providers virtually. But that's just one example. We're trying to create an end-to-end experience that will create greater access to our system and meet consumers where they are.
MH: That strategy has narrowed your margin though, so when do you expect to see results?
Impicciche: I think we're already seeing a positive impact. With online scheduling, for example, I think we've had 100,000 more visits. And that's been during times when the demand has been low. We're trying to increase the top of the funnel, increase access, and make the experience easier.
MH: You recently wrote about gun violence. What voice do you bring to one of the largest Catholic organization in the country?
Impicciche: We see gun violence as a public health issue. And our mission is to advocate for a compassionate and just society. So we're encouraging all Americans to have that conversation.
MH: Do you see yourself having the same connection to the Vatican as your predecessor?
Impicciche: Tony made an incredible contribution to Ascension and to Catholic healthcare. As part of this succession process, Tony began introducing me to the various leaders within the Vatican. I also would expect Tony to continue to help us in our relationships there.
MH: He was very vocal about immigrant rights. So with the public charge rule now finalized, are there any expectations for Ascension to take on additional uncompensated care?
Impicciche: We're very committed to 100% coverage, 100% access. The broadening of that rule puts health coverage at risk for potentially millions of Americans. Nonetheless, regardless of the broadening of that rule, our mission remains unchanged. We will continue to care for the poor and underserved. That's who we are and we will always do that. It's core to our mission and central to who we are.
MH: In Milwaukee, community members are protesting the possible end of services at St. Joseph Hospital. How will Ascension respond?
Impicciche: We have a commitment to our communities. I think the needs of any particular community can change over time; they're dynamic needs. Whether or not that community's needs are best met by operating a hospital or by offering different services is really determined on a case-by-case basis, depending on the community. As you know, we're beginning to stand up a health village in Washington, D.C. We just opened an urgent-care center there. We're looking at the other needs of that particular community and how we might best meet them. So we don't believe that the only way we can serve a community is through operating a hospital. There are many, many ways. We happen to have a lot of hospitals, but we also do a lot of other things. I think first and foremost we're committed to the community and committed to finding ways to best meet their needs, particularly for those who are underserved.
MH: You're a tax expert. What do you see as the biggest challenge for not-for-profits to defend their tax exemptions?
Impicciche: I think the biggest challenge is one of alignment and transparency. As I've said, I believe we have an obligation to our communities, and part of that is to be in a transparent dialogue with them. These can be difficult subjects. But I do think the best way to approach those difficult conversations is in partnership and to have transparent conversations about which services we can bring to help meet community needs. And I think we as a healthcare system, and an industry really, we need to do that better.
MH: What are Ascension's plans to make pricing more transparent?
Impicciche: We support price transparency, but it needs to be meaningful. And chargemaster information is just not meaningful. Plus it doesn't take into account our charity-care policy or other adjustments we make. So transparency around what it would actually cost for a particular procedure, I think makes perfect sense. I would also say that it shouldn't just be transparency for hospitals. If we're going to go down this path, it ought to be transparency for everyone. So whether we're dealing with insurance companies or pharmaceutical companies or health systems, if we're going to have price transparency then we ought to have it for everyone. We are rolling out some tools. Our own associates can use an app that explains benefits and outlines a deductible. And there will be more of these tools for the consumer.
MH: What is Ascension's commitment to value-based care?
Impicciche: As a country, we need to continue to move toward value-based care. I think that we ought to be rewarded for high quality and low cost. As a country we need to get healthcare costs under control. And I think that's probably the best way to do that. Much of our revenue is fee-for-service, so in order to transition over time, it has to be in a very thoughtful way. But I do think ultimately that certainly should be the goal.
MH: Tell me about the Ascension brand. What are the benefits of having a single, national brand?
Impicciche: Having one Ascension brand has allowed us to speak with one voice when it comes to advocating for the poor and vulnerable. It has also made the consumer journey much easier—it connects all 2,700 of our sites of care—both in the physical world and online. It's put us in a position where we can now create Ascension-branded products–something we couldn't do in the past. It has really accelerated our 'one Ascension journey' as we become a truly integrated healthcare system.
MH: Are there any plans for additional growth, either through acquisitions or other methods?
Impicciche: We really don't think about it that way. We continue to be very focused on strengthening Catholic healthcare, and I think the industry will continue to consolidate. That's really where our interest lies—really around strengthening Catholic healthcare. If that results in acquisitions or mergers down the road, so be it.